Self-Rated Health and Adverse Health Outcomes: An Exploration and Refinement of the Trajectory Hypothesis

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Abstract
Objectives. To examine the hypothesis that the relationship between poor self-rated health and adverse health outcomes simply reflects self-assessments of declining health trajectories rather than current health status. Methods. A 12-month follow-up of 786 disadvantaged adults aged 50–99 years old was conducted. Baseline markers of poor self-rated health and declining health trajectory were used to predict 12-month follow-up reports of the expectations of being hospitalized within one year, being placed in a nursing home within five years, and dying within ten years. Hierarchical multivariable logistic regression was used with poor self-rated health entered first, standard epidemiologic covariates entered next, and declining health trajectory entered last. Results. Poor self-rated health was not independently associated with expectations for being hospitalized, but declining health trajectory independently increased the risk of such expectations by 65–88%. Neither poor self-rated health nor declining health trajectory were independently associated with expectations for being placed in a nursing home, but both were independently associated with expectations for dying, increasing such expectations by 70–105%. Discussion. The relationship between poor self-rated health and adverse outcomes is not a simple reflection of unmeasured self-assessments of impending decline or doom. Rather, the effects of poor self-rated health and declining health trajectory appear to be independent and complementary.

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